Priorità e delega in stile NCLEX: pacchetto last-minute

A drowsy patient has an arterial blood gas with pH 7,30, PaCO₂ 58 mmHg (7,7 kPa) and HCO₃⁻ 25 mEq/L (mmol/L). Which problem is the priority?

1. APoor ventilation causing carbon dioxide to build up
2. BLoss of bicarbonate from the bowel through severe diarrhea
3. CHyperventilation caused by anxiety
4. DToo much bicarbonate from antacids

Un paziente riceve nutrizione parenterale attraverso un accesso venoso centrale. Quale reperto richiede un intervento immediato?

1. ASudorazione, tremore e glicemia di 62 mg/dL (3,4 mmol/L) dopo che l'infusione si è interrotta inaspettatamente
2. BUna medicazione asciutta e integra sull'accesso
3. CUn aumento di peso di 0,2 kg da ieri
4. DUna glicemia di 150 mg/dL (8,3 mmol/L) mentre l'infusione è in corso

How should a portable oxygen cylinder be kept in a patient’s room?

1. ASecured upright in a stand or holder
2. BLying loose on the floor beside the bed
3. CLaid on the bed next to the patient
4. DPlaced next to a heater to keep it warm

La mattina dell'intervento, un paziente dice che l'operazione riguarda il ginocchio sinistro, ma il modulo di consenso indica il ginocchio destro. Che cosa deve fare l'infermiere?

1. ASeguire il paziente, perché conosce meglio il proprio corpo
2. BSeguire il modulo di consenso, perché è stato firmato
3. CMarcare entrambe le ginocchia così da poter operare l'uno o l'altro
4. DFermarsi e informare il chirurgo, in modo che la sede venga prima confermata

An older adult with chronic kidney disease takes glyburide (glibenclamide, a sulfonylurea) and has repeated low glucose readings. Why is this a concern?

1. AThe drug stops working entirely when the kidneys fail
2. BThe drug causes high potassium that lowers the glucose
3. CThe drug and its metabolites build up and cause long lows
4. DThe drug makes the glucose meter read falsely low

A patient has eaten very little for 2 weeks and has received broad-spectrum antibiotics. The INR is now 2,3 without warfarin, and the platelets are normal. What is the most likely cause?

1. AHemophilia A
2. BImmune thrombocytopenia
3. CIron-deficiency anemia
4. DVitamin K deficiency

Which advice should be given to a patient with a new permanent pacemaker?

1. AStop all heart medicines straight away
2. BNever raise the arm on that side again
3. CTell staff about the pacemaker before any MRI scan or procedure
4. DAvoid using all household electrical appliances such as kettles

Quale paziente deve valutare per primo un infermiere di reparto all'inizio del turno?

1. AUn paziente in attesa di dimissione con parametri stabili
2. BUn paziente con confusione di nuova insorgenza e frequenza respiratoria di 28/min
3. CUn paziente che chiede un lassativo
4. DUn paziente con lombalgia cronica valutata 4/10

A woman had lymph nodes removed from her left armpit for breast cancer. Which advice helps reduce the risk of lymphoedema?

1. AUse only the left arm for heavy lifting to build up its muscles
2. BApply tight jewellery to the left wrist
3. CAvoid BP cuffs and injections on the left arm where possible
4. DKeep the left arm hanging down and as still as possible all day

A patient with squamous cell lung cancer becomes confused, thirsty and constipated, with abdominal pain. Which electrolyte disturbance is most likely?

1. AHyponatraemia
2. BHypercalcaemia
3. CHypokalaemia
4. DHypomagnesaemia

A patient on ciclosporin or tacrolimus asks about grapefruit juice. Which advice is correct?

1. AIt has no effect on these drugs
2. BDrink it with each dose to improve the absorption
3. CDrink it daily to protect the kidney
4. DAvoid it, because it can raise the drug levels

An older patient with a UTI is now confused, with a respiratory rate of 24/min, BP 88/50 mmHg and a pulse of 120/min. What should happen?

1. ATreat the confusion with a sedative
2. BEncourage oral fluids and wait for the urine culture
3. CGive oral antibiotics and recheck in four hours
4. DStart sepsis care at once, with IV antibiotics and fluids

How should a patient with facial burns usually be positioned?

1. AIn any position that keeps the face covered
2. BWith the head of the bed raised to reduce swelling
3. CLying flat with the head lower than the feet
4. DLying face down on the pillow to protect the airway

On the ward after surgery, a patient has a red, blistered area of skin under where the diathermy plate was. What should the nurse do?

1. AApply a hot water bottle to improve the circulation
2. BWash it with alcohol and leave it uncovered
3. CTreat it as a possible burn, report it and complete an incident form
4. DIgnore it because skin changes after surgery are normal and expected to fade